=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518795897
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STELLAR BEHAVIORAL HEALTH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2024
-----------------------------------------------------
Last Update Date | 01/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 610 CAVE MILL RD STE 200
-----------------------------------------------------
City | BOWLING GREEN
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 42104-4682
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-347-2412
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7145 E VIRGINIA ST STE 2000
-----------------------------------------------------
City | EVANSVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47715-9147
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-962-7894
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | ROBERT ACKER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 859-433-1913
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RA0401X
-----------------------------------------------------
Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------